Friday, 14 December 2007

Too thick for Uni

Nine calls – one treated on scene, two assist-only and six taken by ambulance.

Early evening; not really the time of day you expect to be called to a stabbing – especially not at a reputable university.

My first call directed me to a stand-by point around the corner from the location of the incident. A 20 year-old had apparently been attacked and stabbed somewhere in the student complex and I was waiting for police to arrive. We aren’t allowed to go bowling in without police backup on calls where weapons are known to have been used. The assailant could still be hanging around and the scene could still be dangerous. But I was itching to get on with it. The thought of someone potentially dying as you sit metres away like a frightened rabbit eats at you. The people at the other end of the radio do their best but they can be very slow at informing us of a police presence. I’ve waited for a long time at some of these incidents, only to find out, on my own, that the police have been on scene for a while.

An ambulance arrived and pulled up behind me as I waited. It was still light and there were plenty of people around, so I wasn’t particularly concerned about any imminent threat to us. We waited until the first police car arrived, followed swiftly by another. Now we could go in.

One of the ambulance crew walked into the narrow street where the incident was supposed to have taken place and I followed in the car. The ambulance brought up the rear. I saw a windmill further down the road, at the very end and I moved ahead and got on scene within a few seconds, the others were following behind.

A small group of people were gathered around a young girl – a Uni student. She was conscious and I couldn’t yet see what injury she had, if any. I approached and asked what had happened. I could now see that one of the men with her had placed a dressing pad over her cheek. I peeled it back carefully and saw a small but deep puncture wound just below her eye, it trickled a little blood and was beginning to swell badly.

‘She was stabbed with a knife we think’, said the man in charge. He worked for the University – he may have been a lecturer but I wasn’t sure.

Then the girl told me what had taken place. My colleagues were arriving around me now.

‘I was walking through a common room and there were guys around. One of them punched me in the face as he walked past and when I felt my cheek, it was bleeding. He had a knife in his hand. I saw it when he ran off.’

She wasn’t seriously injured, well, not in a life-threatening way and for that she could be thankful but if her story was true it meant that she was the victim of a completely random attack in a place where people are supposed to be grown up. They are supposed to be highly intelligent, educated individuals.

I remember in my naive youth, believing that University students were the best of the best but that just isn’t true. Nowadays, with entry to Uni being less restrictive than ever before and, to be honest, some subjects created merely as a reason to fill classes and gain funding, bad people with bad brains are now being accepted. They come straight from College or High School and they bring their stupid cultures of violence and aggression with them. When I was at Uni there were elements inside the place causing all kinds of trouble – it ruined the atmosphere for most of the hard-working, serious-minded people who just wanted to learn and get on in life.

The poor girl will be scarred for the rest of her life now. The blade had just missed a cranial nerve. If that had been severed, she may have had a facial palsy too. She can pick up her degree in a few years time with a permanent reminder of the ‘best years of her life’ carved into her face.

I went to Chinatown after that call. An 80 year-old woman with an unknown problem and the caller had hung up before completing the details. Calls like that are always a bit suspicious – or there’s a good reason for the interruption. I got there as fast as I could and there was an ambulance crew on scene ahead of me. My colleagues were out of the vehicle and scanning the buildings for the correct address, which was proving elusive. It was a narrow little street (a lot of the streets around Soho and Chinatown are cramped) so our vehicles, which were parked in the middle of the road, were now causing a tailback.

Eventually the right address was found and we moved our vehicles further down the street, although we were still in the middle of the road and had no choice but to stay there. We went into the building and climbed a set of stairs to the first floor flat. Inside a young Chinese man directed us to his Grandmother, who was sitting on the loo, fully clothed, with a bucket of vomit in front of her. She was pale and sweaty but conscious and alert.

The call confusion had occurred because the young man had a speech problem. He understood English but couldn’t communicate verbally; he had to write things down. His Grandmother spoke no English at all. Now I have to learn Chinese.

His Grandmother was obviously ill but we couldn’t confirm anything about her properly, even with written notes, so we moved her to the ambulance and carried out an ECG and other checks. She appeared to have several anomalies on her ECG, including ST elevation, which may indicate a heart attack, so we got her to hospital on blue lights. She remained stable throughout the journey and I hope she got the care she needed, given the problems that existed with basic communication.

A very nice diabetic man next. The 70 year-old had become hypoglycaemic and his worried relatives had called an ambulance, describing his condition as a ‘diabetic coma’. Obviously I ran to this one thinking I was going to treat an unconscious patient. I arrived to find him sitting up in bed wondering what all the fuss was about.

‘Honestly, I feel fine. Why did they call you? He asked.

‘They said you were acting strangely and that you had diabetic problems. Your blood sugar may be low. Can I check it?

‘Of course but I’m absolutely fine.’

He didn’t look fine. He was diaphoretic, pale and couldn’t string a sentence together without pausing for thought. Sometimes he paused for thought so long I believed he was drifting off to sleep. That, I didn’t want.

I checked his BM and it was low; 2.1 in fact. So my next mission was to raise it to a more normal level. I would settle for 5 or 6 before I left the house and I asked his wife to get a sweet drink for him. She brought in some pineapple juice and I asked him to drink it. At first he wasn’t keen but he complied and drank the lot. Then I asked for another glass of the stuff. He finished that one too.

He was still slow and lethargic but I persevered; this process can take up to 30 minutes to complete. The juice brought his BM up to 4 and I asked his wife to bring a sandwich and biscuits if she had them. Now he needed to fill up on ‘slow-burning’ sugar so that his body could fully recover and sustain itself. He ate the sandwich and munched the biscuits and all the while I’m sitting there starving. I hadn’t eaten and was due a snack, I thought. I’d have to wait ‘til this job was done.

It took 15 minutes for him to improve enough to convince me that he didn’t need to go to hospital. I had cancelled the ambulance on the basis of this call being a simple hypo and his refusal to have one appear and now he was making more sense. I got my paperwork from the car and when I returned, he was sitting in the kitchen with his wife and sister, eating another sandwich. He looked a hell of a lot better. He thanked me for my help and generally praised the ambulance service, and then I was off, happy to have done a simple, life-saving job.

I didn’t get a chance to eat; I was called to another diabetic emergency as soon as I greened up. This time an 80 year-old man was described as having a ‘diabetic fit’ in a public place. I got there and was directed to a reception area by staff. I waited and got ignored.

‘Excuse me’, I asked the receptionist (who was busily chatting to someone), ‘Is there someone in need of an ambulance here?’

‘Yeah’, she quipped, ‘they’re bringing him down in the lift’.

‘Why are they moving him?’

‘I dunno – they’re bringing him down. That’s all I know.’

There must be a special training school, perhaps even a charm school for people like that. I wasn't charmed, however and I let her know.

'They shouldn't be moving the patient, they should have taken me straight to him.'

Her face said 'like I care', so I decided to act.

I went to the lift area and two members of staff came towards me with a man in a wheelchair. He had a friend with him and it was noticeable that none of them were fitting or had been fitting in the recent past. I was told that the man had ‘gone a bit funny’ and, realising his blood sugar had dropped, his friend had quickly sorted him out with glucose sweets which were conveniently kept in his pocket for just such an emergency. This is exactly the sort of self-help that diabetics rely on. They do NOT want to see ambulances showing up for them every time their BM dips a bit. Over-reactive and panicky staff at public places (with more of an eye on liability than responsibility in my book) will dial 999 at the drop of a hat and then use descriptions that simply don’t bear relevance to the situation in order to secure a rapid response. What sounds better to you?

‘I have a diabetic who is a bit confused’ or ‘I have a diabetic who is having a seizure’

I know it’s cynical but the man being wheeled to me was instantly aggressive towards me and his friend, who happened to be a GP and whose nose was definitely put out of joint by my presence, was not happy about the drama that had been unfolded on their behalf. In short, they were acutely embarrassed and I was the target of their humiliation. I can understand it too; if I was treated like an emergency when I was quite capable of treating myself, I would be mortified at this over-the-top response.

Then, as I was calming them both down, the ambulance crew arrived. Oh dear, what have we done?

I checked his BM (I had to really) and he allowed that much. I found it to be normal (quel surprise!) and both men left the building – the ‘patient’ still had to be wheeled out at the insistence of the staff. Why, I don’t know. He wasn't happy at all.

I worked with the same crew on the next call – a 30 year-old female, ‘unconscious on a bus’. Now, this was different. Most of my 'drunk on a bus' patients are male. I got to Lower Regent Street, where the bus had stopped and the driver met me at the door.

‘He’s upstairs. I tried to wake him but he is completely unconscious’, he said. she is a he after all, I thought.

‘Is he drunk?’ I asked, ever hopeful.

‘I don’t think so’.

I went upstairs and there he was, slumped at the very back of the bus, along the seat. He was young and looked out of it, even from a distance. I didn’t think he was drunk either. He wasn’t sleeping; he was unconscious. His breathing was very slow and very shallow. He wasn’t suffering the effects of alcohol.

I tried to rouse him but got nothing but dead weight and heavy limbs. I adjusted his airway and took at look at his eyes. Pinpoint pupils. I worked on the presumption that he had taken a drug, possibly an opiate – probably heroin.

The ambulance hadn’t arrived yet, so I gained IV access and gave him Narcan. The lights were off on the bus and the driver had left me to it. I was up on the deck on my own, in the dark, with a drugged up man who may or may not come out of his stupor soon. I knew that he wouldn’t be the most passive person on Earth when he came round.

He didn’t come round, however and the crew arrived to help me sort him out. I gave him more Narcan and all his obs were completed while we waited. His arms had puncture marks on them, so it was still a highly likely drug-related problem we were dealing with. I hoped I was on the right track. But he didn’t respond to the second injection. He should have improved by now.

The police arrived and watched as we went through a number of other checks and I administered even more Narcan. An OP airway had been inserted and he had tolerated it but only for a few seconds. He spat it out and began to rouse a little. Then he sparked up and began to get aggressive with my colleague who just happened to be near him. He thrashed around and swore at him, threatened him and tried to punch him. The cops moved in immediately and sat on him until he calmed down. Then he slid back into his coma.

I gave him more Narcan and he climbed back up to a point where he was manageable but not awake enough to do any harm. We lifted him down the stairs to the waiting ambulance. I had been on the top deck with him for almost 40 minutes. He remained quiet for the trip to hospital. I gave him no more Narcan; I didn’t need him fully alert.

Back to normal with a 40 year-old female ‘drunk and unconscious’. She was flat on the floor of an exclusive Soho club when I got on scene but she responded to pain, so she wasn’t too bad. She’d still need to go to hospital because she was unfit to travel anywhere else and her friend was cringing with embarrassment. Why do people do that to their friends?

Then there’s GHB – the drug of choice for the (mostly) young gay community. The call took me outside a gay club in the West End. I’ve been here several times recently and I don’t like the place at all – it heaves with drunken, badly behaved individuals who have nothing else on their mind but ‘having a good time’ at the expense of others and the complete and utter disinterest of all else around them, except their own group. They often obstruct our vehicles as we try to get in and will not move from the dance floor, even when we are carrying a patient out.

I didn't know but there was an ambulance crew waiting at a stand-by point down the road. They had been told that the patient was violent and to wait for the police. I had been told nothing. I cruised into the dead-end street, full of people, without a thought. The crew saw me go in and the police, who had arrived in force went right past the street, bless 'em. The crew decided to come and help because they knew that I didn't know what they knew...if you know what I mean.

The police did a U-turn, found the right street and joined in the fun. But there was no need for them.

This young lad was lying in the gutter having ‘fits’, according to witnesses as a result of his recent GHB adventures. He was loud, annoying and at times aggressive to me and the crew, especially the crew. In the vehicle he was cannulated by the ambulance paramedic but he ripped that out as soon as it was in. Then I had a go and he ripped that one out too. He needed fluids but he wasn’t letting us help him. His female friend sat teary-eyed on the chair, watching him make a fool of himself.

I was annoyed with him. He was a spoilt brat as far as I was concerned. Professionally, he was getting all the help he needed and he was being handled properly but personally, I couldn’t care less if he wanted to waste his life using this stuff. The people who pay are the people around him and tonight, right now, it was me, the crew and his crying friends. He will survive his episode because the ambulance service is on hand to scrape him up and take him to a safe place.

At 5am the bread delivery man called for an ambulance when he stumbled across a man with a head injury lying unconscious in the street. I got on scene and he (the bread man) flagged me down. He pointed into an alley and I saw a large man lying in a pool of blood.

‘Did you try to wake him?’ I asked.

‘You must be joking mate, I never went near him!’

I looked at the bread man – he was a good three inches taller than me and a bit wider. I looked at the slumped man. I went over to him and shook him hard. He moved. I shook him again, noting the blood which had formed a pool around his head – he had a nasty gash in his forehead. He had fallen and sustained that injury, or he had been hit. I didn’t know which and when he came round and sat up, he didn’t know either. In fact, he’d rather not go to hospital because he was ‘okay now’. I disagreed and the crew arrived to help him make up his mind. He was taken to hospital.

Another ‘drunk on a bus’ and this time it was a more familiar theme. He was drunk, East European and aggressive. He had crutches with him but denied they were his. He had wet himself and his trousers were loose, always a happy combination. With the help of the crew I managed to get him off the bus but he wasn’t pleased and seemed to be miles away from home.

As the bus drove off I turned around in time to see the man run after it, crutches in hand, and leap back on without the driver knowing what had happened. Oh well, some other poor slob will get that job later on. I’m off home.

Be safe.


Anonymous said...

hi, sometimes we take an age to find out Police are there because they never actually tell us and then have the nerve to chase us up! It annoys us too!

Xf said...


Oh that's a given. I know how bad comms can be between the services. Nothing to do with us foot-soldiers though. I'm sure the police would like us there at the same time too.

Anonymous said...

RE the incident at the university, even 8 years ago it wasn't perfect. An incident occured at one I was in when a foreign student murdered his girlfriend, (also a student) in student accomodation on the grounds itself. It was quite a shock to be woken up at 4am with police going round searching for him.

Unsurprising the state of a lot of people's nerves at the time, meant they didn't do well in the run of exams that week.

Pzycoman said...

Im a diabetic, have been for all 23 years of my life, and i would be extremely embarrassed and even ashamed if the ambu service turned up for one of my hypo's unless it was life threatening. I almost always carry food around with me, if not, I will go and buy some.

thanx said...

wow! you do so much in one night. We really take the services for granted.
You do a fab job,I can only say thank-you for being at our beck and call.

FRUBod said...

as an aside to this one of our major bug bears is FRU's not being on the correct RT channel. How do they expect us to update them quickly? Mobiles arent reliable enough to rely on us calling you quickly. The RT is instant! If theres any calls on sector we need you for we'll call you, theres no need to listen for GB's. Phew. Thanks for listening.